Although few therapies exist for directly decreasing neural tissue damage caused by stroke, much can be done to improve (or worsen) patient outcome. Despite extensive research evidence including randomized control trials and meta-analyses that demonstrate the efficacy of specific acute ischemic stroke therapies and processes of care (i.e. appropriate and timely provision of rt-PA, aspirin, antihypertensives, antiembolics, antithrombotics, mobilization, physical and occupational therapy, and patient and family education), there is evidence to suggest that these therapies are underutilized. The American Heart Association and the American Academy of Neurology have developed and actively disseminated ischemic stroke guidelines regarding these drug therapies and processes of care. The overall goal of this project is to build on our previous AHRQ funded research to assess the effectiveness of a replicable and an innovative model for accelerating the application of evidence-based treatment guidelines for acute ischemic stroke. We will use a randomized controlled design in a voluntary consortium of hospitals (N=24) in Minnesota to test a hospital based intervention involving feedback of both hospital specific clinical performance data and information on relevant personal and interpersonal characteristics of staff and organizational capacity shown to be predisposing and enabling factors associated with organizational change. At the experimental hospitals, we will work with both informal clinical opinion leaders and members of the formal leadership (i.e. CEO, Nursing Director) to use this information to improve performance in the targeted areas. At the control hospitals, we will provide a minimalist intervention involving informal opinion leaders but not hospital leadership.